Chronic Traumatic Aneurysm Research Articles

IP211. Management of Chronic Massive Traumatic Popliteal Artery Aneurysm: A Case Series With Evolution of Treatment

IP211. Management of Chronic Massive Traumatic Popliteal Artery Aneurysm: A Case Series With Evolution of Treatment

Chronic Traumatic Thoracic Aortic Aneurysm: 40-Year Follow-Up.

Traumatic aortic injury is a rare but potentially lethal condition. Those few patients who survive the acute phase of injury usually progress to form a chronic aneurysm. Few guidelines exist on the management of chronic traumatic aortic aneurysms. Here, we describe the conservative management of a patient with a traumatic thoracic aortic aneurysm who has remained asymptomatic for 40 years.

Thoracic aortic aneurysms after blunt trauma

Aortic injury after blunt trauma that is missed during the first admission will soon be seen as a chronic aneurysm. The objective of this study is to show the importance of the diagnosis and appropriate treatment of these aneurysms. Between 2009 and 2012, 8 patients (mean age, 50±31 years) diagnosed with chronic traumatic aortic aneurysm were treated with either thoracic endovascular aortic repair (TEVAR) or conventional surgery 20 years on average after the trauma. Treatments included TEVAR in four patients, conventional surgery in two patients, and hybrid intervention in one patient. One patient died postoperatively. One patient had an endoleak requiring a repeat TEVAR, which was successful. Brachial embolectomy was performed after placing the endovascular stent. No paraplegia or lower extremity ischemia was seen. One patient died preoperatively due to rupture of the aneurysm. Chronic traumatic aortic aneurysms may cause general symptoms years after a blunt trauma. Aortic injury must always be considered in the assessment and follow-up of trauma patients.

Surgical repair for rupture of a chronic traumatic thoracic aneurysm 14 years after injury: report of a case

Traumatic thoracic aortic injury is a lethal condition. Because its mortality rate is extremely high in the acute phase, these patients rarely survive long enough for a chronic aneurysm to develop. We herein report a case of surgical repair for a ruptured chronic traumatic thoracic aneurysm. A 32-year-old man, who had been involved in a traffic accident 14 years earlier, was diagnosed with a rupture of a chronic traumatic thoracic aneurysm. Preoperative computed tomography showed that the ruptured aneurysm arose from the aortic isthmus and was accompanied by multiple daughter lesions. He underwent an aorta graft replacement with reconstruction of the left subclavian artery using both a median sternotomy and a left thoracotomy. The surgery was successful and the postoperative course was uneventful. Chronic traumatic thoracic aneurysm is usually a single lesion, and cases with daughter aneurysms have rarely been reported. We include a review of the previous literature and also discuss the etiology of this condition.

Thenar-Hammer-Syndrom

Chronic traumatic aneurysm of the distal radial artery is rare. The literature offers only 20 cases of chronic traumatic vascular lesions of the thenar region. We present the case of a 58-year-old cheese maker who had done manual work for years and who experienced swelling at the thenar eminence, pain, cold and warm paresthesia and circulatory disturbance in his index finger. Duplex ultrasound and CT angiography revealed an aneurysm of the superficial branch of the radial artery indicating a thenar hammer syndrome. He was subjected to a microsurgical end-to-end repair after resection of the aneurysm. This is the first closely documented case of a true aneurysm of the superficial branch of the radial artery. We also present a comprehensive survey of published studies of chronic vascular lesions of the thenar region related to thenar hammer syndrome and patient occupation, symptoms, diagnostis and therapy.

Recurrent spinal cord ischemia after endovascular stent grafting for chronic traumatic aneurysm of the aortic isthmus

This report describes the development of recurrent spinal cord ischemia in a patient after insertion of a stent graft into the upper segment of the descending thoracic aorta for the treatment of a chronic traumatic aneurysm of the aortic isthmus. Intraoperatively, the stent covered the ostium of the left T7 artery, which was shown to give rise to a middle dorsal artery by postoperative spinal cord arteriography.

Chronic Traumatic Aneurysm of the Left Main Coronary Artery Causing Myocardial Infarction

Chronic Traumatic Aneurysm of the Left Main Coronary Artery Causing Myocardial Infarction

Aortoesophageal fistula as a late complication of aortic transection

Acute aortic transection carries a high mortality, with death occurring in up to 90% of patients and with fewer than 5% surviving for longer than 14 days. Chronic false aneurysm develops in patients who survive an acute aortic rupture without operation. 1 Chronic traumatic aortic aneurysm involves either partial or complete disruption of at least the intima and media and develops 3 months or more after a major deceleration injury. The natural history of chronic pseudoaneurysms is unclear. Most likely, thrombus develops within the disrupted portion of the aortic wall and then forms a fibrous wall that calcifies with time. Later on, it may expand or even rupture. It has been reported that 20-year survival of patients with chronic traumatic aortic aneurysm is around 60%, with half having symptoms by 10 years and a third dying of late rupture. 2 Symptoms develop as a result of aneurysm expansion and its impact on surrounding structures. Back pain is the most common presentation. Other presenting features include dyspnea, hoarseness, paraplegia, hemoptysis, dysphagia, hematemesis, and sudden death. We describe a case of successful repair of chronic traumatic aortic aneurysm that was initially seen with esophageal bleeding and collapse. Clinical Summary A 32-year old man was referred for surgical opinion after an episode of collapse. This episode was associated with hematemesis

Surgical repair for chronic traumatic thoracic aneurysm after 12-year follow-up

A 39-year-old man underwent surgical repair of chronic traumatic thoracic aneurysm after 12-year follow-up at our hospital. Eighteen years prior to surgery, he had been involved in a traffic accident, suffering a left hemopneumothorax. Chronic traumatic thoracic aneurysm is extremely rare that few guidelines for surgical intervention exist for this disorder. However, it has been observed that all patients with new symptoms should be operated promptly, and that asymptomatic aneurysm detected over 2 years after the initial trauma can be monitored by careful follow-up pending symptomatic or radiologic change. The present case provides additional support for these strategies.

Stenting of the thoracic aorta – the radiologist's view

BACKGROUND: Endoluminal stent graft repair is emerging as a less invasive alternative to conventional open surgery in the management of diseases of the descending thoracic aorta. In this overview we will discuss the current concept of stent graft therapy of various diseases of the thoracic aorta from an interventional radiologist's point of view. METHODS: Since 1996, 84 patients with atherosclerotic aneurysms of the descending thoracic aorta, aortic dissections, acute traumatic ruptures, chronic traumatic aneurysms and penetrating atherosclerotic ulcers underwent endoluminal stent graft repair at our institution. 18 patients presented with life-threatening symptoms and were treated on an emergency basis. All procedures were performed in an angiographic suite with state-of-the-art digital subtraction angiographic equipment. Follow-up was at 1, 3, 6, and 12 months after treatment and yearly thereafter. RESULTS: The primary technical success rate ranged from 78% to 95%, the 30-day mortality rate was 7% if including elective as well as emergency interventions. Endoleaks were the most common procedure-related complications. They occurred at a rate of 11% and had to be treated by extension cuffs or additional endograft segments. Data of our institution are presented in comparison to the current literature. CONCLUSIONS: Stent graft repair of thoracic aortic aneurysms, aortic dissections and related pathologies is a fascinating new technique offering a less invasive treatment option to patients who are unsuitable for surgical repair. For patients at high surgical risk, endovascular stent graft placement can be advocated as standard therapy.

Chronic traumatic aneurysms of the descending thoracic aorta: mid-term results of endovascular repair using first and second-generation stent-grafts.

Endovascular stent-graft repair holds promise for treating traumatic injuries of the descending thoracic aorta. The durability of this approach, however, remains unknown. The objective is to evaluate the mid-term results of stent-graft repair of chronic traumatic aneurysms of the descending thoracic aorta. Between 1993 and 2000, endovascular repair of the descending thoracic aorta with first (custom-fabricated) and second-generation (commercial) stent-grafts was performed in 15 patients (mean age 54+/-13 years) at an average of 18+/-14 years after the injury. Because of comorbidities, 4 patients (27%) were judged not to be reasonable surgical candidates for conventional open surgical approach. Follow-up was 100% complete and averaged 55+/-29 months. Stent-graft deployment was successful in all without need for surgical conversion. One patient died early postoperatively. No neurologic complications occurred. Two patients had a primary endoleak, one of them was successfully treated before discharge. Actuarial survival estimates at 1 and 6 years were 93+/-6% and 85+/-10%. Actuarial freedom from reintervention on the descending thoracic aorta was 93+/-6% and 70+/-15% at 1 and 6 years, respectively. Actuarial freedom from treatment failure (a conservative, all-encompassing performance indicator including endoleak, device mechanical fault, reintervention, late aortic-related death, or sudden, unexplained late death) at 1 and 6 years was 87+/-8% and 51+/-15%. Stent-grafting is safe in selected patients with chronic traumatic aneurysms and associated with satisfactory-but not optimal-mid-term durability. Serial follow-up surveillance imaging is mandatory to detect late stent-graft complications. Younger, good risk patients should be offered conventional open operation, reserving stent-grafting for those who are at prohibitive operative risk or who have limited life expectancy.

Surgery of chronic traumatic aneurysm of the aortic isthmus: benefit of direct suture.

Retrospective evaluation of long term results after direct suture repair of chronic traumatic aneurysm of the aortic isthmus. From March 1979 to June 1998, a total of 19 patients with chronic traumatic aneurysm of the aortic isthmus were operated on, among whom 12 (63%) underwent direct suture. These 12 patients (age ranging from 19 to 68 years; mean 34.2 years) constitute the subject of this study. All but one suffered traffic accidents. Mean delay between trauma and surgery was 4 years (range 3 months to 12 years). All patients underwent a left posterolateral thoracotomy through the fourth intercostal space. Extracorporeal circulation for spinal cord protection was installed in six patients (five ilio-iliac shunts, one atrio-iliac shunt). Aortic rupture was partial in five and circumferential in seven patients. The mean clamping time was 25 min. The absence of loss of aortic substance and a careful mobilization of the aorta made the repair by direct suture easier; this technique could thus be achieved in 63.2% of all 19 patients operated on of chronic traumatic aneurysm within the same period. There was no in-hospital death and no postoperative paraplegia. With a median follow-up of 15 years 3 months (ranging from 22 to 10 years), there were no late complications. Chest X-ray was normal in all patients; eight of them underwent a control angiography between 18 and 72 postoperative months; all these angiographies but one (20% stenosis without gradient) demonstrated a normal appearance of aortic isthmus. Direct suture for repair of chronic traumatic thoracic aneurysm is a safe procedure: long-term outcome was excellent and the complications observed with prosthetic grafts or with aortic endoprosthetic stent-grafts were avoided.

Operation for chronic traumatic aortic aneurysm: when and how?

Background. There are few guidelines for surgical intervention late after unoperated traumatic aortic rupture. We reviewed our experience and the literature to determine when and how to operate. Methods. Between 1987 and 1997, we treated 9 patients aged 22 to 82 years with chronic traumatic aneurysm. Seven patients underwent aneurysm resection. Two patients have not been operated on. The injury-to-operation interval ranged from 8 weeks to 18 years (mean, 4.1 years). One patient underwent median sternotomy and patch repair during hypothermic circulatory arrest. Six patients underwent left thoracotomy: 2 were operated on with left atrio–femoral bypass, and 4 with hypothermic circulatory arrest and ascending aortic cannulation. Results. There was no surgical mortality or morbidity. The 2 patients who were not operated on remained asymptomatic without radiologic change in the aneurysm after follow-up of 2 and 9 years. Conclusions. From this limited experience and literature review, we make the following subjective observations: (1) all patients with new symptoms should be operated on promptly, and (2) asymptomatic densely calcified aneurysms detected more than 2 years after the accident can be observed by repeated tomography unless new symptoms arise.

A CASE REPORT OF CHRONIC TRAUMATIC ANEURYSM OF THE THORACIC AORTA

We experienced a case of chronic traumatic aneurysm of the thoracic arota due to a traffic accident. This paper presents the case with a review of the relevant literature in Japan. A 26-years-old man was seen at the hospital because of an abnormal shadow on a chest X-ray film which was incidentally found 7 years after blunt trauma on the chest at the traffic accident. With contrast enhanced CT and angiography of the chest, the patient diagnosed as having a chronic traumatic aneurysm of the thoracic aorta. The patient was asymptomatic, but was operated on because of possible enlargement of the aneurysm and risk of rupture. Operative procedures included left posterolateral thoracotomy and grafting under partial extracorporeal circulation. Postoperative course was uneventful without particular complication. The patient was discharge from the hospital on the 18th hospital day. Chronic traumatic aneurysm of the thoracic aorata is a rare disease. If the disease is suspected from a blunt trauma on the chest, early diagnosis followed by surgical operation is essential.

Chronic traumatic thoracic aneurysm: Report of two cases with the question of timing for surgical intervention

Chronic traumatic thoracic aneurysm: Report of two cases with the question of timing for surgical intervention

Chronic traumatic thoracic aneurysm: Report of two cases with the question of timing for surgical intervention

We report on two symptom-free patients with chronic thoracic aneurysms related to prior trauma and address the timing for surgical intervention. In addition, we reviewed our institutional experience with similar cases for the period 1970 to 1990. Although natural history data remain incomplete, we propose that in the setting of improved imaging modalities, it may be reasonable to manage this group of patients nonoperatively and intervene surgically only when symptoms develop or there is radiologic evidence of aneurysm change.

Chronic traumatic aneurysms of the thoracic aorta.

During the last 10 years (1975-1985), a total of 18 cases of posttraumatic aneurysm at the level of the thoracic isthmus were operated on. Six of the 18 were women (19-71 years of age) and 12 were men (17-61 years of age). The mean age at the time of injury was, respectively, 22 and 25.8 years and, at the time of operation, 34.5 and 35.5 years. The patients were all involved in a motor vehicle accident, except for 2 (1 falling, 1 crushing). Thirty-nine percent of the patients had no apparent thoracic injury and 89% had associated injuries (bony fractures, craniofacial, visceral and abdominal). Eight of the 18 were asymptomatic at the time of operation, the others had various symptoms (pain, fever, dyspnea, cough, hoarseness, murmur, or hemoptysis). Enlargement of the aortic button was present in every case. Seventeen patients were operated on electively from 4 months to 50 years after the injury. Circumferential rupture was total in 9 patients and partial (2/3 to 9/10) in the others. Complete repair was done by either prosthetic Dacron tube (3), Dacron patch (2), or direct suture (12). Protection by femoro-femoral bypass was used in 3 and simple aortic cross-clamp was used in 14. Mean time of aortic cross-clamp was 36.9 minutes (range, 16-80 min). Among these 17 patients, there was no hospital mortality and no late death. One patient had regressive paraplegia. One patient was submitted to an emergency operation for an intrapulmonary rupture of an infected aneurysm and died in the operating room before completion of the repair.(ABSTRACT TRUNCATED AT 250 WORDS)

A CASE REPORT OF CHRONIC TRAUMATIC DISSECTING ANEURYSM TYPE IIIb

A rare case of chronic traumatic dissecting aneurysm of DeBakey type IIIb was managed radically under temporary axillofemoral bypass.A 47-year-old male had been suffering from hypertension for five years. He was treated two and half years ago for a blow to the chest wall caused by a traffic accident. Six months ago he was admitted to a neighboring hospital with transient lack of consciousness. Chest roentogenogram demonstrated evidence of widening of the mediastinum, prominence of the aortic knob and tracheal shift to the right. Digital subtraction angiogram (DSA) showed type IIIb dissection oridinating distal to the left subclavian artery and re-entering in the region of the celiac artery. Under temporary bypass between the right axillary and right femoral arteries, a 26 mm woven Dacron graft was inserted at the aneurysmal lesion of thoracic aorta, and the re-entry lesion was reconstructed with a Dacron patch. Postoperatively, he has been well without complications, and examinations including DSA have demonstrated favorable results.

Concomitant Repair of a Chronic Traumatic Aortic Aneurysm with Tracheal Erosion

Tracheal erosion from a chronic false aneurysm secondary to trauma is unusual. Resection with graft interposition is the treatment of choice. This case report describes the additional use of an intrathoracic muscle flap necessitated by tracheal erosion and contamination.

Traumatic aneurysms of the descending thoracic aorta

From July 1979 to December 1985 we observed 51 patients with traumatic lesions of the descending thoracic aorta. Twenty-nine had acute ruptures, mostly accompanied by multiple injuries, and 27 had to be operated upon immediately. Twenty-two patients (19 males, 3 females) had chronic traumatic aneurysms of the descending thoracic aorta (more than six weeks after trauma). Mean age at the time of trauma was 24 years. Mean age at time of surgery was 36.5 years. Twelve patients were symptomatic. All were treated surgically. At surgery, complete aortic disruption was found in 15 patients and partial rupture in seven. We did not use aortic shunting of any kind, only aortic cross-clamping. Hypertension was controlled by intravenous drug infusion. The ruptured aortic segment was replaced in all cases by prosthetic Dacron graft. There were no operative deaths. One patient (age 77) died 11 weeks after surgery from multiple organ failure. One case of postoperative paraplegia was observed. This patient recovered almost completely from his neurological deficit.